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PubMed1989

Relations between visual acuity, refraction and the pattern reversal visual-evoked cortical potential in aphakia.

The investigations included 20 aphakic patients. Relations were established between visual acuity, refraction and the pattern reversal visual-evoked cortical potentials (PRVECP). Close correlations were found between the three values. The optimum correction for obtaining best visual acuity, the skiascopic value, and the correction value for obtaining the largest PRVECP amplitude at minimum peak time differ by an average of 0.5 dptr.

Aged↗
PubMed1981

Epikeratophakia: the surgical correction of aphakia. II. Preliminary results in a non-human primate model.

We have developed a new form of refractive surgery, epikeratophakia, in which a disc of donor corneal tissue is lathed to a specific dioptric power and sutured on top of the recipient's cornea after the recipient epithelium has been removed. The optical correction obtained with epikeratophakia should be similar in quality to that of a contact lens, but would be permanent and would require no maintenance. A non-human primate model was used to test the predictability, stability, and clarity of epikeratophakia grafts. After surgery, the grafts did not always re-epithelialize readily; this problem has been solved with the use of a small, steep, soft bandage contact lens. For the nine month period of this study, the epikeratophakia grafts have remained clear and the curvatures of the anterior surfaces have remained constant. However, the actual visual potential of these grafts can be evaluated only by a controlled clinical study in humans.

Animals↗
PubMed1993

Ocular growth in infant aphakia. Bilateral versus unilateral congenital cataracts.

In a prospective study the changes in the ocular axial lengths and in the overall refractions were examined in cases of unilateral and bilateral congenital cataract requiring surgery during the first year of life. Measurements were taken on 18 children with unilateral and on 20 children with bilateral congenital cataract at the time of surgery and up to eight years postoperatively. Surgery was performed via a pars plana/plicata approach, and all infants were fitted with contact lenses. In cases of unilateral cataract, the ocular axial length tended to be superior to the age-matched values already prior to surgery. After four to eight years, one third of the eyes were clearly above normal. In cases of bilateral cataract, the axial lengths were reduced at the age of surgery in the majority of cases, and particularly in eyes that required surgery during the first six months of life. The curvatures of the contact lenses tended to remain unchanged in bilateral cataract, and decreased by about 0.7 mm in unilateral cases. This also reflects the high degree of microphthalmia in bilateral cases. After four to eight years, the degree of microphthalmia had usually increased. The overall refraction decreased significantly in unilateral and bilateral cataract during the first four years of life. The mean values were higher in bilateral than in unilateral cataract at all ages. The mean decrease was 15 diopters in unilateral cataract (SD +/- 5.5 dpt), and 10 diopters in bilateral cataract (SD +/- 6 dpt). When correlating the age-matched differences in the ocular axial lengths at the time of surgery with the overall refractions after four to eight years, a good correlation was found in the unilateral cases (eight eyes), and a poor correlation in the bilateral cases (24 eyes). The data indicate that intraocular implants should not be used in bilateral cataract requiring surgery during the first year of life as long as there is no possibility to change their refraction while in place. In unilateral cases, a relatively accurate prediction appears possible in a small number of eight eyes. However, an additional important correction with glasses would be needed before reaching the final refraction resulting in a high degree of aniseiconia, and eliminating the chances for binocular vision that are small anyway. Furthermore, data from other authors would indicate that the change in refraction may be much more important than expected when using intraocular implants in unilateral congenital cataract requiring surgery during the first year of life.(ABSTRACT TRUNCATED AT 400 WORDS)

Aphakia, Postcataract↗
PubMedDate not supplied

The use of epikeratophakia grafts in pediatric monocular aphakia.

Epikeratophakia is a form of refractive surgery in which the recipient's epithelium is removed and a pre-shaped donor lenticule is sutured to the patient's cornea. Seventeen patients ranging in age from two months to 6.6 years received 19 epikeratophakia grafts for the correction of aphakic vision. The correction provided by the graft in combination with vigorous amblyopia therapy has yielded some improvement in vision in the 12 patients with successful grafts. This procedure may be particularly suitable for pediatric aphakic patients because it is extraocular and reversible and may be employed as a secondary procedure or in conjunction with cataract extraction. Only with longer follow-up of these and additional patients can these preliminary results be validated and the risk/benefit ratio of this procedure be assessed.

Aphakia, Postcataract↗
PubMedDate not supplied

The association of strabismus and aphakia in children.

Strabismus was present in 40% of patients with cataracts/dislocated lenses at the time of initial diagnosis and continued to present an obstacle to complete rehabilitation with 86% of the congenital patients and 61% of the acquired patients found to have strabismus at their latest post therapy visits. The type of horizontal deviation found at the initial examinations was distributed equally between esotropia and exotropia in the unilateral congenital cataracts patients. However, all of our patients with strabismus and bilateral congenital cataracts were esotropic. The acquired group was heavily weighted toward the exodeviations at the time of the initial examination and during treatment showed an even greater percentage of exotropia. Visual acuity results in the various groups followed perhaps the expected trends with the poorest results in the unilateral congenital cataract patients. Those patients in the acquired groups have better visual results with 56% of the traumatic and 83% of the non-traumatic eyes achieving vision of 20/70 or better. Despite the high incidence of strabismus present in these patients, we feel this should in no way be a deterent to the decision to initiate therapy as it does not seem to relate to visual acuity results. The overall good visual results in these patients justifies the approach of early surgery, adequate correction, and vigorous occlusion.

Adolescent↗
PubMedDate not supplied

Cystoid macular edema in pediatric aphakia.

The presence of cystoid macular edema (CME) after cataract extraction in the pediatric age group could adversely affect rapid visual rehabilitation of the eye by contributing to irreversible amblyopia. Several previous studies, including one by our group, have addressed this problem. Hoyt's observations of CME in ten of 27 eyes undergoing lensectomy-vitrectomy procedures have stirred renewed interest in this topic. The current study includes 12 eyes undergoing lensectomy-vitrectomy procedures, five eyes undergoing manual extracapsular procedures (ECCE) with discission of the posterior capsule, three eyes undergoing ECCE without discission of the posterior capsule, and three eyes undergoing secondary discissions. No CME was found angiographically on postoperative evaluation.

Aphakia, Postcataract↗
PubMedDate not supplied

Visual acuity in monocular pediatric aphakia: does epikeratophakia facilitate occlusion therapy in children intolerant of contact lens or spectacle wear?

Twenty-two children had a monocular cataract extracted between 1981 and 1986. Twelve of these patients eventually tolerated a monocular contact lens or anisometropic spectacle wear. Eleven patients initially would not tolerate conventional therapy, and epikeratophakia was performed. Of the 12 patients tolerating a contact lens or spectacles, eight (67%) now see 20/60 or better, and six (50%) see 20/40 or better. Only one (10%) of the patients maintaining the epikeratophakia graft developed vision as good as 20/70. Epikeratophakia did not facilitate occlusion therapy for amblyopia. The critical factor in the development of good vision following monocular cataract extraction was the patient's willingness to patch the better eye, not the method of correcting the refractive error.

Aphakia, Postcataract↗
PubMedDate not supplied

Rigid gas permeable contact lens correction of aphakia following congenital cataract removal during infancy.

Rigid gas permeable (RGP) contact lenses were prescribed and worn with little difficulty by 10 consecutive aphakic infants. Fluoroperm 92 lenses were used instead of silicone lenses (Bausch & Lomb) because of their lower cost, ease in handling, flexibility in design, and better neutralization of astigmatism. Lenses were worn on a daily wear basis (with occasional overnight wear) to reduce the risk of keratitis. Keratometry readings were taken at the time of surgery with the patient in a supine position. Trial lens fitting was performed 1 to 7 days later using a Burton Lamp. None of the patients developed keratitis, corneal neovascularization, or the sucked-on-lens syndrome. The lenses were well tolerated and the parents soon became adept at handling them. We now use RGP lenses as our lens of choice when treating aphakic infants.

Aphakia, Postcataract↗
PubMedDate not supplied

Multifocal versus monofocal correction of neonatal monocular aphakia.

We compared the efficacy of monofocal and multifocal intraocular lenses (IOLs) as a means of optically rehabilitating eyes with monocular congenital cataracts using a primate model. A congenital cataract was simulated in the right eye of 20 monkeys from birth to 2 weeks of age with an opalescent contact lens. A lensectomy was then performed and a monofocal IOL was implanted in 11 eyes and a multifocal IOL in 9 eyes. Any residual refractive error was then corrected with an extended-wear contact lens. The fellow eyes were then randomized to no treatment or 70% occlusion therapy. Grating acuity was assessed using forced-choice preferential looking with Teller acuity cards at regular intervals. At 32 weeks of age, the pseudophakic eyes were mildly amblyopic, but the grating acuities were not significantly different between the pseudophakic eyes with multifocal versus monofocal IOLs or between subjects who had received occlusion therapy versus no treatment of the fellow eye. We conclude that at least through 32 weeks of age, multifocal and monofocal IOLs are of similar efficacy and occlusion therapy may be less important to prevent amblyopia from developing in pseudophakic eyes compared to contact-lens corrected aphakic eyes.

Amblyopia↗
PubMedDate not supplied

Congenital aphakia.

Explore the source record for details and available documents.

Anterior Eye Segment↗
PubMedDate not supplied

Congenital corneal staphyloma associated with aphakia.

A neonate had a globular mass bulging through the eyelids of the left eye. Computed tomography revealed a large ectatic corneal lesion and the absence of a lens. The enucleated globe revealed that the posterior surface of the ectatic cornea was lined by iris tissue, indicating corneal staphyloma.

Aphakia↗
PubMed2000

[Intraocular correction of aphakia after cataract extraction for uveitis in adolescents].

PURPOSE: To demonstrate 3 cases with pediatric pseudophakia after cataract extraction as a complication of unilateral uveitis. MATERIAL AND METHODS: The boys were at the age of 8, 11 and 15 years at the moment of surgery. Uveitis was monocular, the etiology unknown and clinically significant cataract was diagnosed after several months from the beginning of inflammation. The last recurrence of uveitis was observed 1 to 6 months before operation. There were intermediate uveitis (2 cases) and anterior uveitis (1 cases). In 2 eyes PMMA implant was placed in-the-bag and in one eye in the ciliary sulcus. During surgery we did not observe any complications except greater tendency to bleeding. Follow-up after operation ranged from 1.5 to 2.5 years. RESULTS: Visual acuity before cataract extraction was 0.01; 0.04 and 0.02 and during last visit after surgery it was 0.9, 0.6 and 0.4 respectively. Postoperative near distance visual acuity was 0.5, 0.75 and 1.25. We observed cystoid macular oedema in the latter case. Two months after PC-IOL implantation the symptoms of mild inflammation in the eye of 15-year-old boy with anterior uveitis occurred. Intraocular pressure before and after operation ranged from 12 to 17 mm Hg. Corneal central endothelial cell density was from 2850/mm2 to 3100/mm2 before and from 2469/mm2 to 2979/mm2 during last visit. CONCLUSION: Cases of posterior pseudophakia during uveitis in children showing good functional and anatomical state of eyes in the long term observation after IOL implantation recommend the intraocular correction in carefully selected uveitic pediatric patients.

Adolescent↗